In the traditional outreach
model, an organization’s paid staff members—often
trusted community members or former drug users—are the outreach workers.
Studies conducted during the 1980s and 1990s showed that IDUs often help these
outreach staff carry out their prevention work. IDUs help introduce the outreach
workers to new communities and distribute prevention materials. They also help
outreach workers locate very high-risk, hard-to-reach injectors.

In the past 10 years, this involvement by IDUs has led to the development
of a new outreach model, called peer-driven intervention (PDI). This innovative
social network model relies entirely on IDUs to carry out the major outreach
functions. IDU outreach workers locate their peers, provide education and information,
and help peers obtain services and treatment. The IDUs work closely with health
educators who are trained to conduct HIV testing and refer users to health
care and other services.

PDI differs from other outreach models because the IDU workers are paid a
small sum for each peer they recruit. This is the way it works: Each IDU worker
is offered 2-3 coupons for use in locating and educating drug-using peers and
recruiting them to come to a storefront HIV prevention facility. When the peers
go to the storefront, they turn in their coupons and are given a knowledge
test to see how well they were educated by the IDU workers. The worker is paid
a small sum of money for each peer they successfully educate and recruit to
the storefront. The peers who come to the storefront then become IDU workers
and are offered 2-3 coupons to educate and recruit other peers.

PDI has several strengths:

Because each IDU worker recruits several peers who then recruit
other peers, PDI can reach a large and diverse group of IDUs who might not
be reached
by traditional outreach methods. Example: 4 IDUs who get 3 coupons each
can recruit 12 peers. If those 12 peers get 3 coupons each, they can recruit
36
peers, and so on.

Getting money for each successfully educated and recruited peer
is strong motivation for IDUs to reach out to their own peers and spread
prevention messages.

Repeating HIV education messages to several peers helps IDUs become
more knowledgeable about HIV risk and prevention. Involving IDUs in prevention
work also helps
them reduce their own HIV risk behaviors.

Because IDUs in the PDI model are working “on commission” rather
than on a salary, PDI can be much less expensive than traditional outreach.

A small number of studies have shown that PDI can reach
more drug users than traditional outreach at less cost and that it can reduce
high-risk behaviors
and improve HIV knowledge among IDUs. Researchers are continuing to test and
refine the model in a variety of settings here in the U.S. and in other countries.
This research and continued use in communities will help reinforce these initial
findings.